Toenail Fungus

 

What is toenail fungus?  Toenail fungus is known as onychomycosis which can affect both the toenails and fingernails. The fungus may cause the nails to become thicker, discolored, disfigured or it may cause splitting. 

Thickened toenails can cause pain due to pressing against the inside of the shoes, leading to irritation, pressure and curvature of the toenails if they are not properly treated.  

 

Who gets toenail fungus? Toenail fungus can happen to almost anyone but it appears to be on the rise due to the increased diagnosis of Diabetes. Also aging, hygiene and a weakened immune system can play a factor.

 

How can it be treated? Fungus of the toenails can be treated in various ways

1. Topical antifungal. The medication is usually a cream or liquid and needs to be applied daily for several months to one year to see improvement

 

2. Oral antifungal medication: There are several oral medications on the market but before I prescribe any of these medications, the patient must get a liver function test to make sure that the liver is healthy enough to support the medicine.

 

3. Laser toenail treatment: Laser toenail therapy utilizes a heat laser.

 

4. Removal of the toenails

 

Will I be cured? At Integrative Foot and Ankle Centers of Washington, we will do a thorough evaluation to discover the best treatment option of you. Just as all feet are not the same, no one treatment is the same for every individual.

Also, we strive for excellence but none of the treatments may cure the fungus 100%

 

Are you sure that it's fungus? Some bacterial infections and changes of the toenails related to aging can mimic toenail fungus. A biopsy of the toenail may be performed in the office to discovery what  offending organism may be in the toenail.

 

 

Schedule your consultation today

 

 

 

 

 



 

 

 

 



Ankle Fracture

Ankle Fracture

A broken ankle is commonly known as a fracture. There may be one or more bones broken.
The ankle is made up of 3 bones: the tibia, the fibula, and the talus. The fractures can range in severity which can allow some people to remain walking on it whereas others may not be able to walk for months.

Patients usually describe a fall or a twisting injury to the ankle which causes pain, swelling, bruising and difficulty walking or inability to place pressure on the foot or ankle.

Ankle fractures may be evaluated by X-ray. But further imaging studies such as a CT scan, MRI or an arthrogram may be necessary to discern if there is some soft tissue damage to ankle ligaments or tendons.
Some fractures can be treated with either a cast or a CAM walker (walking boot) where some others need to be surgically repaired.

Ankle injuries are serious and can be debilitating if left untreated. Schedule an appointment at Integrative Foot and Ankle Centers of Washington for a prompt and thorough examination.

Orthotics

Orthotics 

What are they?

Orthotics are devices that can be applied to your shoes to provide structural or supportive changes.

Why do I need them?

Orthotics can be used for conditions such as flat foot, bunions, hammertoes, neuromas, amputations and heel spurs. They are also helpful for people who stand or walk frequently throughout the day.

What if I'm a Diabetic?

Orthotics can also be used to provide cushion and reduce pressure and friction in Diabetic patients.

Will they help if my feet hurt while working out?

Orthotics can be be useful to maximize your walking or running routine. 

How do I get a pair?

Come into the Renton office for an evaluation of what type of orthotics will be best for your individual needs.

Do you have a callus or a wart?

Many patients come into the office with painful lesions on the bottom of the foot. Some patients will have self diagnosed their condition and even begun a treatment regimen of topical creams, ointments, salves or even compound products (2 or more elements (medications) mixed into one).
Usually these products don't work or the patient is not seeing the results that they expect, so they appear in the office for a consultation.

Usually a scraping of the lesion with a scalpel blade is necessary to determine exactly what kind of lesion is on the foot. This scraping is usually not painful.
Different types of lesions:
Callus usually form in areas of pressure or friction. They usually appear yellow or gray.

Warts are viruses caused by Human Papilloma Virus (HPV). Warts have many different color variations such as gray, brown, or pink. Some have dark spots throughout or A single dark spot in the middle. Warts will not usually go away on their own if the immune system is weakened.

Treatment for calluses is usually shaving the lesion down and applying cream to soften them.

Treatment for warts usually consists of shaving down the lesion, freezing the lesion, applying Salicylic Acid and covering the lesion to prevent it from breathing. Laser therapy can even be performed.

My office can help you determine what lesion you may have and perform the appropriate treatment option. We also have a state of the art laser. Stop by for a consultation.

Morton's Neuroma

 

 

Morton's Neuroma

 

Morton's neuroma has been known by several other names: Morton's metatarsalgia, Morton's neuralgia, plantar neuroma and intermetatarsal neuroma)

Patients will often complain of  pain and/or numbness of their forefoot in between the 2nd and 3rd or 3rd and 4th metatarsals heads.  The pain is usually elicited by shoe gear (pain when the toes are pressed together inside of the shoe) or with a pressing motion (such as pressing on the brake during driving), or walking.

The term was first described by a Chiropodist Lewis Durlacher in 1845. Although it is a called a Neuroma, it is believed to be a perineural fibroma rather than a true tumor.

Although the best way to visualize a neuroma is by ultrasound or MRI, a standard x-ray may also be taken to rule out any trauma like a fractures or a bone lesion or arthritis. Standard x-ray will not typically show soft tissue lesions.

Ultrasound can also be used to guide therapeutic Cortisone injections to alleviate painful symptoms associated with the Morton's Neuroma.

 

Widely used forms of conservative treatments for Morton's Neuroma are orthotics and corticosteroid injections. An addition to traditional orthotic arch supports, a small foam or fabric pad may be positioned under the space between the two affected metatarsals. This pad helps to separate the metatarsal bones and create more space for the nerve so as to relieve pressure and irritation. Unfortunately it may cause mild uncomfortable sensations of its own, such as the feeling of having an awkward object under one's foot.

Corticosteroid injections can relieve inflammation and pain in some patients and help to alleviate the symptoms. However, the inflammation and pain recur after some weeks or months, and corticosteroids can only be used a limited number of times because they cause damage to the ligaments and tendons of the foot.

Sclerosing alcohol injections are also a treatment alternative if  other conservative methods fail. A direct injection of 4% alcohol can be placed into the area of the neuroma, causing toxicity to the fibrous nerve tissue.
Most often,  this treatment must be performed 2–4 times at 1–3 weeks intervals.

Another treatment modality of Morton's Neuroma is Radio Frequency Ablation. The effectiveness of the treatment is speculative.

Surgery is often the last resort and a procedure known as neurectomy (which involves removing the affected piece of nerve tissue), may be performed.
A postoperative scar tissue formation (stump neuroma) can occur in approximately 20% of cases, causing a return of neuroma symptoms

 

 

Oh No! I broke my toe!

Broken Toes

Oh No! I broke my Toe!

 

Many patients present to the office with suspected broken toes. Any toe can be broken but in my professional experience, the most commonly broken toes are the 4th or the 5th.  I'm not sure if it is because they are generally the smallest and therefore easier to break. But most patients state that they are the most bumped toes in the middle of the night.

Broken toes should not be confused with broken metatarsals which are the long bones of the foot that sit behind the toes.

 

 

Metatarsals

 

Toe

A broken toe is relatively quick to heal in a healthy patient. The standard protocol is rest, ice, compression and elevation. I also like to buddy splint the toes together (with a guaze in between prevent sweating between the toes, as shown in Pic 1), and the use of an offloading shoe.

There are times when a broken toe is very serious and that it when there is an open fracture (break in the skin). This type of fracture pushes the break through the skin which can allow bacteria to penetrate into the body.
This type of fracture usually requires a Tetanus shot, thorough cleaning of the wound, possible stitches (depending on the time frame of when the injury occurred and time of treatment) or surgical management.

Plantar Fasciitis

Plantar Fasciitis

Many patients present to the office with pain in the heels. Most patients describe it as a stabbing sensation that is worse in the morning and usually begins to improve as they walk around. They also state that the symptoms will return if they sit for an extended period of time.

Although I tell most of my patients that all heel pain isn't Plantar Fasciitis, majority of the time, it is. That being said though, when patients present to the office, I still get x-rays to help rule out a fracture, Tarsal Tunnel, or plantar fibromas.
Some patients present to the office with pain in the feet and heels which is originating from the back. So I always try to perform a thorough physical examination.

Q: So what is Plantar Fasciitis?
A: It is pain and inflammation of the Plantar Fascia

Q: What is a plantar fascia?
A: The plantar fascia is a band of ligaments that connects your heel bone to your toes. It helps to support the arch of your foot. If you strain the plantar fascia, it gets weak, swollen, inflamed and irritated. This often leads to pain of your heel bone or the bottom of your foot hurts when you stand or walk.

Q: How did I get this?
A: There are numerous reasons
-You have flat feet which cause the foot to roll inward toward the midline of the body when you walk. This is know as excessive pronation.
-You have high arches
-You are overweight
-Your shoes are worn out or don't fit well
-You spend large periods of time walking, standing or running on hard or uneven surfaces
-Your Achilles tendon or calf muscles are too tight

Q: How can I make this pain better?
A: There are several treatment options that I discuss with my patients
-Stretching with a towel or resistance band or stretching the toes against a hard surface such as a wall several times per day
-A steroid injection. I usually mix this injection with a local anesthetic to reduce pain. The steroid is to reduce inflammation, which also helps to relieve pain as well.
-Referral to physical therapy. There are several modalities that can be used to reduce the painful symptoms of plantar fasciitis and these usually help a lot of people
-Orthotics. The use of orthotics can help reduce the painful symptoms. The must be worn in a pair of good supportive shoes. Unfortunately, flip flops are not the type of shoes that orthotics can be worn in (#1 question asked by patients).
The cost of orthotics may not be covered by some insurance plans.
-Surgical management. I tell patients that this is the last resort. It is important to try to exhaust all conservative methods first before undergoing surgery.

Fun fact: There is 2 I's in Fasciitis. Although most people write it with only 1.